Antithrombotische Therapie bei pAVK und Aortenerkrankungen

Zusammenfassung

Patienten mit peripherer arterieller Verschlusskrankheit (pAVK) oder Aortenerkrankungen haben ein hohes Risiko für kardiovaskuläre Ereignisse. Gerinnungshemmende Medikamente verbessern die Prognose und haben daher einen hohen Stellenwert. Bei jeder gerinnungshemmenden Therapie sollte das individuelle Blutungsrisiko berücksichtigt werden und eine individuelle Nutzen-Risiko-Abwägung durchgeführt werden. Patienten mit symptomatischer pAVK sollten einen Thrombozytenaggregationshemmer (TZAH) erhalten. Bei hohem Risiko für kardiovaskuläre Ereignisse und niedrigem Blutungsrisiko wird die Kombination von Acetylsalicylsäure (ASS) 100 mg und Rivaroxaban 2 × 2,5 mg empfohlen. Liegt ein hohes Blutungsrisiko vor, ist Clopidogrel ASS vorzuziehen. Bei Patienten mit Aortenerkrankungen (z. B. komplexe Plaques, Aortenaneurysma) ist die Gabe eines TZAH indiziert. Patienten mit einer atherosklerotischen Gefäßerkrankung und Indikation für eine orale Antikoagulation wegen Vorhofflimmern oder venöser Thromboembolie sollten keinen zusätzlichen TZAH erhalten. Denn dieser erhöht das Blutungsrisiko, ohne die Prognose zu verbessern.

Abstract

Patients with lower extremity arterial disease (LEAD) or aortic diseases are at increased risk for cardiovascular events. Antithrombotic drugs are highly indicated because they improve the prognosis. Individual bleeding risk should be assessed in each case. Patients with symptomatic LEAD should receive an antiplatelet drug. In patients with high thrombotic and low bleeding risk the combination of acetyl salicylic acid (ASA) 100 mg and rivaroxaban 2.5 mg twice daily is indicated. In patients with high bleeding risk single antiplatelet therapy is recommended and Clopidogrel should be preferred over ASA. In patients with aortic disease (complex plaques, aortic aneurysm) antiplatelet drugs are indicated. If full dosage anticoagulation is indicated because of concomitant atrial fibrillation or venous thromboembolism there is no need for additional antiplatelet therapy because of no benefit and increase of bleeding risk.

Was ist wichtig?

• Bei Patienten mit pAVK ist eine gerinnungshemmende Therapie indiziert. Patienten mit hohem Risiko für kardiovaskuläre und/oder Beinereignisse und niedrigem Blutungsrisiko sollten ASS 100 mg und Rivaroxaban 2 × 2,5 mg erhalten. Bei hohem Blutungsrisiko ist Clopidogrel 75 mg empfohlen.

• Für Patienten mit komplexen Aortenplaques oder Aneurysmen wird in der Regel eine gerinnungshemmende Therapie mit einem TZAH empfohlen.

• Bei Indikation für eine Antikoagulation und pAVK oder Aortenerkrankung ist es normalerweise nicht notwendig, einen TZAH zu ergänzen.

Schlüsselwörter

Thrombozytenaggregationshemmer - Aortenerkrankungen - periphere arterielle Verschlusskrankheit

Keywords

lower extremity arterial disease - aortic diseases - antiplatelet therapy

Publication History

Article published online:
05 December 2022

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